̽��ֱ�� of Cambridge - Michael Weekes

Cambridge researchers join new £2 million UK consortium to tackle monkeypox outbreak

cjb250 — Wed, 19 Oct 2022 23:01:27 +0000

̽��ֱ��consortium has received £2 million from the Biotechnology and Biosciences Research Council and the Medical Research Council, both part of UK Research and Innovation (UKRI). It is led by the Pirbright Institute and the MRC- ̽��ֱ�� of Glasgow Centre for Virus Research.

Researchers will work closely with experts at government agencies – the Animal and Plant Health Agency, UK Health Security Agency, and Defence Science and Technology Laboratory – to study the current outbreak and inform the public health response in the UK and internationally.

Cambridge scientists Professor Geoffrey Smith from the Department of Pathology and Professor Mike Weekes from the Cambridge Institute for Medical Research and Department of Medicine are among the key scientists involved in the consortium.

Professor Weekes said: "Monkeypox has become a really important global pathogen, reaching more than 50 countries worldwide in a matter of months. Although we have an effective vaccine and treatment, global roll-out has so far proved challenging, emphasising the importance of a comprehensive understanding of this virus. ̽��ֱ��UK consortium includes researchers from multiple different disciplines, and I anticipate the data we generate will rapidly help understand how the virus can be targeted in new ways to prevent disease."

Professor Smith said: “Few would have predicted that monkeypox virus would be causing a global epidemic in 2022. ̽��ֱ��ability to respond quickly to this new challenge has been helped greatly not just by the swift and welcome response of UKRI, but also by decades of support for the study of orthopoxviruses from UKRI and the Wellcome Trust. ̽��ֱ��information gained from those studies is valuable in the fight against monkeypox virus.”

̽��ֱ��monkeypox virus outbreak originated in West Africa. ̽��ֱ��current worldwide outbreak of cases spreading outside this area was first identified in May 2022. This is the first time that many monkeypox cases and clusters have been reported in non-endemic areas.

In the UK there have been more than 3,400 confirmed cases since May, although case numbers are currently falling. Internationally, WHO reports it has spread to 106 countries and territories with 25 confirmed deaths.

Professor Melanie Welham, Executive Chair of BBSRC, said: “One of the real strengths of the UK’s scientific response to disease outbreaks is the way that we can draw on leading researchers from all over the country, who can pool their expertise to deliver results, fast. Long-term support for animal and human virus research has ensured we have the capability to respond with agility.

“This new national consortium will study the unprecedented monkeypox outbreak to better understand how to tackle it. This will feed rapidly into global public health strategies, developing new diagnostic tests and identifying potential therapies.”

̽��ֱ��consortium will focus on building our understanding in a number of key areas, including:

Developing new tests and identifying potential control measures:

Developing sensitive point-of-care tests to speed up diagnosis, such as lateral flow tests or LAMP* tests. ̽��ֱ��lateral flow test development will be conducted with Global Access Diagnostics (GADx) to develop a product which could later be manufactured at scale and used clinically worldwide, including in low/middle income countries.
Screening potential drugs to treat monkeypox in human cells in the lab to determine which ones could be developed for further testing.
Studying the virus, how it infects humans and its susceptibility to the immune response to identify targets for future therapies.

Studying the virus:

Characterising the genome of the virus and studying how it is evolving, and how this is linked to changes in the transmission and pathology of the virus.
Understanding the human immune response to the virus and the vaccine, including studying samples from infected individuals.
Identifying animal reservoirs and potential spill-over routes of transmission between animals and humans.

Learning from the vaccine roll-out:

Studying the effectiveness of the smallpox vaccine by tracking the immune responses after primary and secondary vaccination of up to 200 individuals.

Professor Bryan Charleston, co-lead from ̽��ֱ��Pirbright Institute, said: “ ̽��ֱ��implications of the current monkeypox outbreak are huge. As well as tackling the current outbreak, we also need to be fully prepared for next outbreak, because worldwide there’s a huge reservoir of infection. One of the key ways we can do this is to develop rapid tests, which are very important to help clinicians on the front line to manage the disease.”

Professor Massimo Palmarini, co-lead from the MRC- ̽��ֱ�� of Glasgow Centre for Virus Research, said: “Monkeypox is public health challenge, so taking decisive, collective action to better understand this virus is paramount. By bringing together research expertise in different areas, we will harness the UK’s world-leading knowledge to learn more about how the virus works and spreads and provide the foundations for the development of potential new treatments.”

Adapted from a press release from UKRI

Cambridge is among 12 institutions across the UK that will be working together to tackle the monkeypox outbreak, developing better diagnostic tests, identifying potential therapies and studying vaccine effectiveness and the virus’ spread.

Few would have predicted that monkeypox virus would be causing a global epidemic in 2022

Geoffrey Smith

BlackJack3D

Monkeypox virus - 3D render

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Upgrading PPE for staff working on COVID-19 wards cut hospital-acquired infections dramatically

cjb250 — Tue, 29 Jun 2021 07:20:09 +0000

̽��ֱ��findings are reported by a team at the ̽��ֱ�� of Cambridge and Cambridge ̽��ֱ�� Hospitals (CUH) NHS Foundation Trust. ̽��ֱ��research has not yet been peer-reviewed, but is being released early because of the urgent need to share information relating to the pandemic.

Until recently UK Infection Protection Control guidance recommended that healthcare workers caring for patients with COVID-19 should use fluid resistant surgical masks type IIR (FRSMs) as respiratory protective equipment; if aerosol-generating procedures were being carried out (for example inserting a breathing tube into the patient’s windpipe), then the guidance recommended the use of an FFP3 respirator. ̽��ֱ��guidance has recently been updated to oblige NHS organisations to assess the risk that COVID-19 poses to staff and provide FFP3 respirators where appropriate.

Since the start of the pandemic, CUH has been screening its healthcare workers regularly for SARS-CoV-2, even where they show no symptoms. They found that healthcare workers caring for patients with COVID-19 were at a greater risk of infection than staff on non-COVID-19 wards, even when using the recommended respiratory protective equipment. As a result, its infection control committee implemented a change in respiratory protective equipment for staff on COVID-19 wards, from FRSMs to FFP3 respirators.

Prior to the change in respiratory protective equipment, cases were higher on COVID-19 wards compared with non-COVID-19 wards in seven out of the eight weeks analysed by the team. Following the change in protective equipment, the incidence of infection on the two types of ward was similar.

̽��ֱ��results suggest that almost all cases among healthcare workers on non-COVID-19 wards were caused by community-acquired infection, whereas cases among healthcare workers on COVID-19 wards were caused by both community-acquired infection and direct, ward-based infection from patients with COVID-19 – but that these direct infections were effectively mitigated by the use of FFP3 respirators.

To calculate the risk of infection for healthcare workers working on COVID-19 and non-COVID-19 wards, the researchers developed a simple mathematical model.

Dr Mark Ferris from the ̽��ֱ�� of Cambridge’s Occupational Health Service, one of the study’s authors, said: “Healthcare workers – particularly those working on COVID-19 wards – are much more likely to be exposed to coronavirus, so it’s important we understand the best ways of keeping them safe.

“Based on data collected during the second wave of the SARS-CoV-2 pandemic in the UK, we developed a mathematical model to look at the risks faced by those staff dealing with COVID-19 patients on a day to day basis. This showed us the huge effect that using better PPE could have in reducing the risk to healthcare workers.”

According to their model, the risk of direct infection from working on a non-COVID-19 ward was low throughout the study period, and consistently lower than the risk of community-based exposure.

By contrast, the risk of direct infection from working on a COVID-19 ward before the change in respiratory protective equipment was considerably higher than the risk of community-based exposure: staff on COVID-19 wards were at 47 times greater risk of acquiring infection while on the ward than staff working on a non-COVID-19 ward.

Crucially, however, the model showed that the introduction of FFP3 respirators provided up to 100% protection against direct, ward-based COVID-19 infection.

Dr Chris Illingworth from the MRC Biostatistics Unit at the ̽��ֱ�� of Cambridge, said: “Before the face masks were upgraded, the majority of infections among healthcare workers on the COVID-19 wards were likely due to direct exposure to patients with COVID-19.

“Once FFP3 respirators were introduced, the number of cases attributed to exposure on COVID-19 wards dropped dramatically – in fact, our model suggests that FFP3 respirators may have cut ward-based infection to zero.”

Dr Nicholas Matheson from the Department of Medicine at the ̽��ֱ�� of Cambridge, said: “Although more research will be needed to confirm our findings, we recommend that, in accordance with the precautionary principle, guidelines for respiratory protective equipment are further revised until more definitive information is available.”

Dr Michael Weekes from the Department of Medicine at the ̽��ֱ�� of Cambridge, added: “Our data suggest there’s an urgent need to look at the PPE offered to healthcare workers on the frontline. Upgrading the equipment so that FFP3 masks are offered to all healthcare workers caring for patients with COVID-19 could reduce the number of infections, keep more hospital staff safe and remove some of the burden on already stretched healthcare services caused by absence of key staff due to illness. Vaccination is clearly also an absolute priority for anyone who hasn’t yet taken up their offer.”

̽��ֱ��research was funded by Wellcome, the Addenbrooke’s Charitable Trust, UK Research and Innovations, and the NIHR Cambridge Biomedical Research Centre.

Reference
Ferris, M, Ferris, R et al. FFP3 respirators protect healthcare workers against infection with SARS-CoV-2. DOI: 10.22541/au.162454911.17263721/v1

When Addenbrooke’s Hospital in Cambridge upgraded its face masks for staff working on COVID-19 wards to filtering face piece 3 (FFP3) respirators, it saw a dramatic fall – up to 100% – in hospital-acquired SARS-CoV-2 infections among these staff.

Healthcare workers – particularly those working on COVID-19 wards – are much more likely to be exposed to coronavirus, so it’s important we understand the best ways of keeping them safe

Mark Ferris

Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust

Healthcare worker wearing FFP3 mask

Yes

Single dose of Pfizer BioNTech vaccine reduces asymptomatic infections and potential for SARS-CoV-2 transmission

cjb250 — Fri, 26 Feb 2021 08:42:58 +0000

̽��ֱ��study by a team at Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust (CUH) and the ̽��ֱ�� of Cambridge analysed results from thousands of COVID-19 tests carried out each week as part its screening programmes on hospital staff who showed no signs of infection.

Vaccination for health care workers on the CUH site began on 8 December 2020, with mass vaccination from 8 January 2021. During a two-week period between 18 and 31 January 2021, the team screened similar numbers of vaccinated and unvaccinated staff using around 4,400 PCR tests per week.

̽��ֱ��results were then separated out to identify unvaccinated staff, and staff who had been vaccinated more than 12 days prior to testing (when protection against symptomatic infection is thought to occur). ̽��ֱ��study, which is yet to be peer-reviewed*, found that 26 out of 3,252 (0·80%) tests from unvaccinated healthcare workers were positive. This compared to 13 out of 3,535 (0.37%) tests from healthcare workers less than 12 days post-vaccination and 4 out of 1,989 (0·20%) tests from healthcare workers at 12 days or more post-vaccination.

This suggests a four-fold decrease in the risk of asymptomatic COVID-19 infection amongst healthcare workers who have been vaccinated for more than 12 days (75 percent protection). ̽��ֱ��level of asymptomatic infection was also halved in those vaccinated for less than 12 days.

Dr Mike Weekes, an infectious disease specialist at CUH and the ̽��ֱ�� of Cambridge’s Department of Medicine, who led the study, said: “This is great news – the Pfizer vaccine not only provides protection against becoming ill from SARS-CoV-2 but also helps prevent infection, reducing the potential for the virus to be passed on to others.

“This will be welcome news as we begin to plot a roadmap out of the lockdown, but we have to remember that the vaccine doesn’t give complete protection for everyone. We still need social distancing, masks, hand hygiene and regular testing until the pandemic is under much better control.”

Dr Nick Jones, first author on the study and an infectious diseases/microbiology registrar at CUH, said: “Our findings show a dramatic reduction in the rate of positive screening tests among asymptomatic healthcare workers after a single dose of the Pfizer-BioNTech vaccine. This is fantastic news for both hospital staff and patients, who can be reassured that the current mass vaccination strategy is protecting against asymptomatic carriage of the virus in addition to symptomatic disease, thereby making hospitals even safer places to be.”

Giles Wright, programme director for the CUH Vaccination Hub said: “Throughout the pandemic so far, we have taken a systematic approach to keeping our staff safe and well. ̽��ֱ��huge efforts of all those involved in the testing, tracing and vaccination programmes at CUH are making the plan a reality. We are very encouraged by the findings of our research. It gives further hope for the near future.”

When the team included symptomatic healthcare workers, their analyses showed similar reductions. 56 out of 3,282 (1·71%) unvaccinated healthcare workers tested positive. This compared to 8 out of 1,997 (0·40%) healthcare workers at 12 or more days post-vaccination, a 4·3-fold reduction.

̽��ֱ��researchers have released their data ahead of peer review because of the urgent need to share information relating to the pandemic.

This work was supported by Wellcome, the Medical Research Council, NHS Blood & Transplant, Addenbrooke’s Charitable Trust and the NIHR Cambridge Biomedical Research Centre.

Reference [See below for final reference]
Jones, NK et al. Single-dose BNT162b2 vaccine protects against asymptomatic SARS-CoV-2 infection. 24 Feb 2020; DOI: 10.22541/au.161420511.12987747/v1

New data from Addenbrooke's Hospital in Cambridge suggests that a single dose of the Pfizer BioNTech vaccine can reduce by 75% the number of asymptomatic SARS-CoV-2 infections. This implies that the vaccine could significantly reduce the risk of transmission of the virus from people who are asymptomatic, as well as protecting others from getting ill.

This is great news – the Pfizer vaccine not only provides protection against becoming ill from SARS-CoV-2 but also helps prevent infection, reducing the potential for the virus to be passed on to others

Mike Weekes

Asymptomatic staff testing | Michael Weekes

geralt

Coronavirus

*Update: 8 April 2021

̽��ֱ��study has been peer-reviewed and published in eLife:

Reference
Jone, NK et al. Single-dose BNT162b2 vaccine protects against asymptomatic SARS-CoV-2 infection. eLife; 8 April 2021; DOI: 10.7554/eLife.68808

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Cambridge academics recognised in 2021 New Year Honours

sc604 — Thu, 31 Dec 2020 09:52:29 +0000

Professor Simon Baron-Cohen, Director of Cambridge’s Autism Research Centre and a Fellow of Trinity College, has been knighted for services to autism research and autistic people. He is one of the top autism researchers in the world, and is a Fellow of the British Academy, the Academy of Medical Sciences, and the British Psychological Society. He served as Chair of the NICE Guidelines for autism and is Director of the charity the Autism Centre of Excellence and Vice President of the National Autistic Society. He was President of the International Society for Autism Research. He created the first clinic worldwide to diagnose autism in adults and championed the human rights of autistic people at the UN. He is author of ̽��ֱ��Essential Difference, Zero Degrees of Empathy, and ̽��ֱ��Pattern Seekers, which have captured the public imagination.

Professor Baron-Cohen said: “This honour came as a complete surprise, and I accept it on behalf of the talented team of scientists at the Autism Research Centre in Cambridge, and on behalf of the Autism Research Trust, the charity that has supported us. ̽��ֱ��basic needs and human rights of autistic people and their families are still not being met by statutory services, due to insufficient funding, so we are creating a new charity, the Autism Centre of Excellence, to address this gap.”

Professor Usha Goswami, Director for the Centre for Neuroscience in Education, Professor of Cognitive Developmental Neuroscience and Fellow of St. John’s College, becomes CBE for services to educational research.

Her research focuses on children’s cognitive development, particularly the development of language and literacy. Her world-leading work on dyslexia led to the discovery that children with the disorder hear language differently, showing it to be a language disorder and not a visual disorder as previously thought. This significant finding is enabling the development of transformative new educational interventions, which will benefit millions of children with dyslexia worldwide.

“I am deeply honoured to receive this award,” said Professor Goswami. “I have been interested in children’s development since training as a primary school teacher and it is wonderful to have my research recognised in this way.

Professor Val Gibson, Professor of High Energy Physics at the Cavendish Laboratory, ̽��ֱ�� Gender Equality Champion and Fellow of Trinity College, has been made OBE for service to Science, Women in Science and Public Engagement.

Her research interest is the search for new phenomena using particles containing heavy quarks, which are produced in copious amounts at the Large Hadron Collider, and hold the key to our understanding of the matter-antimatter imbalance in the Universe. From 2004-2008, she was the UK Spokesperson and PI for the LHCb experiment and had ultimate responsibility to deliver the UK contributions to the experiment. She is currently the Chair of the LHCb Collaboration Board, the decision-making body for the experiment, with representatives from 78 institutes across the world.

Professor Gibson said: “It is an honour to be recognised for all three of my passions: research into the most fundamental particles and forces of nature, including the mystery of why we live in a Universe made of matter and not antimatter; support for gender equality and diversity in science; and the public engagement activities I have undertaken over many years.”

Dr Michael Weekes from the Cambridge Institute for Therapeutic Immunology and Infectious Disease (CITIID) has been awarded the British Empire Medal for or services to the NHS during COVID-19. He developed a comprehensive COVID-19 screening programme for Cambridge ̽��ֱ�� Hospitals healthcare workers, Cambridge ̽��ֱ�� staff and students.

Dr Weekes said: "I’m deeply honoured to have had the chance to be part of the team that set up COVID testing for Cambridge ̽��ֱ�� Hospitals. I’d particularly like to acknowledge the contribution of Steve Baker, Rob Howes and Giles Wright, who played vital roles in testing and organisation. I hope that vaccination will soon mean that hospitals become even safer places to work and be cared for."

Researchers from the ̽��ֱ�� of Cambridge have been recognised in the 2021 New Year Honours, in recognition of their outstanding contributions to society.

L-R: Simon Baron-Cohen, Usha Goswami, Val Gibson

Yes

Vice-Chancellor’s awards showcase impact and engagement during the pandemic

ta385 — Mon, 05 Oct 2020 12:38:48 +0000

Now in their fifth year, the awards were made in five categories: collaboration, early career, established academic, professional service, online and remote.

̽��ֱ��winners of the collaboration category are Dr Michael Weekes from Cambridge Institute for Medical Research, and Dr Steven Baker from Cambridge Institute for Therapeutic Immunology and Infectious Disease. They collaborated to establish a comprehensive rapid turn-around COVID-19 testing platform for Cambridge ̽��ֱ�� Hospitals healthcare workers, ̽��ֱ�� staff and students.

̽��ֱ��newly-established ‘online and remote engagement’ award goes to Dr Michael Ramage and team from the Department of Architecture for their HappyShield project. This involved developing, testing, and disseminating a novel open-source medical face shield to help tackle severe PPE shortages caused by the COVID-19 pandemic, focussing in particular on production in Low and Middle Income Countries.

̽��ֱ��winner of the early career researcher award is Chioma Achi from the Department of Veterinary Medicine. Achi organised an engagement programme across Nigeria to strengthen the participation of poultry farmers in the fight against antimicrobial resistance.

̽��ֱ��winner of the established researcher award is Dr Duncan Astle from the MRC Cognition and Brain Sciences Unit. Working in partnership with children’s charities, local education authorities, academy chains and local schools, Astle led an engagement programme providing teachers with robust evidence to help young people overcome cognitive and behavioural barriers to learning.

̽��ֱ��winner of the professional services award is Dr Rosalyn Wade from the Museum of Zoology. Wade reimagined the Museum’s learning and public programme following COVID-19 lockdown and the venue’s temporary closure. She designed and released a new blog and developed an innovative online festival (Zoology Live!).

̽��ֱ��awards were announced on 5th October by the ̽��ֱ��’s Public Engagement team on Twitter.

Professor Stephen Toope, Vice-Chancellor of the ̽��ֱ�� of Cambridge, says:

“ ̽��ֱ�� ̽��ֱ��’s mission is to contribute to society. One of the ways we do it is by undertaking research with real social, cultural and economic impact.

“These awards celebrate research that best demonstrates social, cultural and economic impact through engagement. From advances in healthcare and industrial processes, to rapid responses to the global pandemic; from cultural activities that recognise diversity in our societies, to new knowledge that improves teaching and increases social mobility. This year’s panel of judges was inspired and uplifted by the quality of applications.”

̽��ֱ��Vice-Chancellor’s Research Impact and Engagement Awards were established to recognise and reward outstanding achievement, innovation and creativity in devising and implementing ambitious engagement and impact plans that have the potential to create significant economic, social and cultural impact from and engagement with and for research. Each winner is offered a bursary to support their project.

This year’s winners and runners up are:

Established Academic Award

Winner: Dr Duncan Astle (MRC Cognition and Brain Sciences Unit, School of Clinical Medicine) – Breaking barriers to learning in the classroom

Runners up: Dr Joseph Webster (Faculty of Divinity, School of Arts and Humanities) – Sectarianism in Scotland and the repeal of the Offensive Behaviour at Football Act

Professor Peter Hutchinson (with Professor David Menon) (Clinical Neurosciences / Medicine, School of Clinical Medicine) – Reshaping the treatment of traumatic brain injury

Early Career Researcher Award

Winner: Chioma Achi (Department of Veterinary Medicine, School of Biological Sciences) – Strengthening participation of poultry farmers in the fight against antimicrobial resistance

Runners up: Emma Soneson (Department of Psychiatry, School of Clinical Medicine) – Public health approaches to identifying and responding to mental health difficulties in children and young people

Dr Naures Atto (Asian and Middle Eastern Studies/Middle Eastern Studies, School of Arts and Humanities) – Endangered Middle Eastern Cultures and their Vulnerability in Migration Contexts

Dr Nicki Kindersley (Faculty of History, School of Humanities and Social Sciences) – Militarised political economies in South Sudan

Professional Services Award

Winner: Dr Rosalyn Wade (Museum of Zoology, School of Biological Sciences) – Learning and Public Programme of the Museum of Zoology: blending contemporary zoological research with active and online learning experiences for public audiences

Collaboration Award

Winner: Dr Michael Weekes and Dr Steven Baker (Cambridge Institute for Medical Research / Cambridge Institute for Therapeutic Immunology and Infectious Disease, School of Clinical Medicine) – A comprehensive COVID-19 screening programme for Cambridge ̽��ֱ�� Hospitals healthcare workers, Cambridge ̽��ֱ�� staff and students

Runners up: Dr Victoria Avery, Dr Melissa Calaresu and Dr Miranda Stearn (Fitzwilliam Museum / Faculty of History / Fitzwilliam Museum) – Feast & Fast: ̽��ֱ��Art of Food in Europe, 1500–1800 Research Project

Online and Remote Engagement Award

Winner: Dr Michael Ramage and team (Department of Architecture, School of Arts and Humanities) – ̽��ֱ��HappyShield

Runners up: Centre for Geopolitics (Department of Politics and International Studies, School of Humanities and Social Sciences) – Centre for Geopolitics Coronavirus Response

Academics, students and professional members of staff from across the ̽��ֱ�� have been recognised in this year’s Vice-Chancellor’s Research Impact and Engagement Awards for their work in areas including COVID-19 testing, PPE production and online engagement.

These awards celebrate research that best demonstrates social, cultural and economic impact through engagement

Stephen Toope

Happyshield

̽��ֱ��Happyshield face shield

Yes

Licence type:

Attribution

Unexpected experiences: Mike Weekes describes setting up a full-scale COVID-19 testing facility

zs332 — Thu, 27 Aug 2020 08:00:00 +0000

When infectious diseases expert Mike Weekes realised he and colleagues had know-how that could help protect staff, patients and students in a pandemic, they set up a unique testing facility – the first of its kind, they believe, in a UK university.

Rapid genome sequencing and screening help hospital manage COVID-19 outbreaks

cjb250 — Tue, 14 Jul 2020 22:30:00 +0000

Since the start of the UK pandemic, when the virus was spreading between people, a team of scientists and clinicians at the ̽��ֱ�� of Cambridge and Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust (CUH) have been reading the genetic code of the virus to see if cases within the hospital are connected. This has enabled the hospital to fully investigate these outbreaks and to improve infection control measures to reduce the risk of further infections.

In addition, the introduction of a screening programme that involved repeat testing of staff, has helped the hospital to investigate clusters of COVID-19 infections, informing infection control measures and breaking chains of transmission. This has helped reduce the number of hospital-acquired infections, ensuring maximum safety for patients and staff as the NHS aims to re-start other services.

Researchers have published details of these investigations in two peer-reviewed journals, Lancet Infectious Diseases and eLife.

Genomic surveillance

Researchers in Cambridge have previously pioneered the use of genome sequencing as a way of managing hospital infections such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE) and Clostridium difficile. They have also used real-time sequencing to rapidly identify transmission chains in epidemics such as the Ebola epidemic in Sierra Leone.

̽��ֱ��researchers have now turned their attention to COVID-19.

SARS-CoV-2, the coronavirus that causes COVID-19, is an RNA virus and as such its genetic code is prone to errors each time it replicates. It is currently estimated that the virus mutates at a rate of 2.5 nucleotides (the A, C, G and T of genetic code) per month. Reading – or ‘sequencing’ – the genetic code of the virus can provide valuable information on its biology and transmission.

As part of the COVID-19 Genomics UK (COG-UK) Consortium, researchers have been sequencing all available positive samples from patients admitted to the hospital with COVID-19 infection as well as a selection of samples collected from patients in regional hospitals across the East of England.

In a five week period from mid-March to late April, the team sequenced over 1,000 viral genomes. They used phylogenetic trees – akin to a ‘family tree’ – to look at how clusters of virus samples might be related, allowing them to help pinpoint particular wards or locations where the disease was spreading.

Dr Estée Török from the Department of Medicine at the ̽��ֱ�� of Cambridge said: “Genome sequencing gives us a rapid and reliable way of identifying cases of COVID-19 infection that are closely related within the hospital. This approach can provide vital information to help us to investigate the possible routes of transmission and to improve infection control measures to limit the spread of infection.”

̽��ֱ��researchers analysed 299 COVID-19 patients and found 35 clusters of genetically identical viruses involving 159 patients. By examining the patients’ medical records and ward location data researchers identified strong links between 58% of cases and plausible links between 20% of cases. ̽��ֱ��epidemiological and genomic data were fed back to the hospital infection control and management teams resulting in implementation of a range of measures to prevent further transmission, including isolation of infected patients, revised procedures for ward cleaning, enhanced use of personal protective equipment (PPE) and changes in staff social distancing behaviour.

As an example, six dialysis patients were admitted to different locations in the hospital with COVID-19 infection over a three-week period. Sequencing revealed that their viral genomes were identical. Epidemiological investigation showed that the patients dialysed at the same outpatient dialysis unit on the same days of the week and identified shared patient transportation and neighbouring dialysis chairs as risk factors for transmission. This enabled the infection control team to enhance infection control measures and prevented additional cases.

Professor Ian Goodfellow, from the Department of Pathology at the ̽��ֱ�� of Cambridge, said: “We’re able to combine genomic data with patients’ medical records to provide real time information to help the hospital review its infection control on a weekly basis. It’s also highlighted possible transmission networks less well documented, such as care homes, outpatient units and ambulance services.”

̽��ֱ��COVID-19 Genomics UK Consortium is supported by funding from the Medical Research Council, part of UK Research & Innovation (UKRI), the National Institute of Health Research and the Wellcome Sanger Institute.

Screening asymptomatic and symptomatic healthcare workers

In addition to genomic surveillance, CUH has implemented a screening programme in which all staff – both symptomatic and asymptomatic – are screened.

In May, Cambridge researchers reported that of the more than 1,000 staff members reporting fit for duty during April, 3% tested positive for the coronavirus.

Now, in a follow-up study published in eLife, they have found that, alongside a decline in patient admissions with COVID-19, the proportion of both asymptomatic and symptomatic healthcare workers testing positive declined rapidly throughout the following month.

̽��ֱ��team performed 3,388 tests at CUH between 25 April and 24 May. These included 2,611 tests on asymptomatic healthcare workers. ̽��ֱ��samples were analysed using a technique called PCR to detect genetic information from the virus on the swab.

̽��ֱ��researchers found that just 21 (0.8%) of the 2,611 tests carried out on asymptomatic healthcare workers returned positive, a large drop compared to the previous month.

Of the 771 tests carried out on symptomatic healthcare workers or those living with someone with possible infection, just 13 (1.7%) were positive – compared to 13% the previous month.

Dr Mike Weekes, from the Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), said: “Screening all staff at the hospital regardless of whether they are showing symptoms has helped us see a dramatic fall in the number of hospital-acquired infections. It means we’re able to spot new outbreaks faster, limiting their opportunity to spread.

“It’s important not to be complacent, though. There will inevitably be new outbreaks that occur – that is, unfortunately, the nature of a pandemic. But we hope our approach will help reassure both staff and patients that the hospital remains a safe place to give and receive care.”

In their report, the team give an example of where four symptomatic staff from the same general medical ward tested positive. In response, the team was able to carry out targeted screening of staff on the ward, allowing them to identify a cluster of infections and prevent further onward transmission.

“ ̽��ֱ��existence of clusters of infection in specific areas of the hospital shows the potential for staff and patients to become infected within the hospital environment,” said Professor Steve Baker from CITIID. “If left unchecked, these clusters could lead to self-sustaining outbreaks. Frequent testing at CUH allowed us to spot these clusters quickly and stop any further transmission.”

̽��ֱ��research was supported by Wellcome, the Addenbrooke’s Charitable Trust, the Medical Research Council, NHS Blood and Transfusion, National Institute for Health Research Cambridge Biomedical Research Centre and Cancer Research UK.

Reference

Meredith, LW, Hamilton, WL, et al. Rapid implementation of real-time SARS-CoV-2 sequencing to investigate healthcare-associated COVID-19 infections. Lancet ID; 14 July 2020; DOI: 10.1016/S1473-3099(20)30562-4

Jones, NK, Rivett, L, Sparkes, D, and Forrest, S et al. Effective control of healthcare worker SARS-CoV-2 transmission in a period of declining community prevalence of COVID-19. eLife; 19 June 2020; DOI: 0.7554/eLife.59391

Cambridge researchers have shown how rapid genome sequencing of virus samples and enhanced testing of hospital staff can help to identify clusters of healthcare-associated COVID-19 infections.

This approach can provide vital information to help us to investigate the possible routes of transmission and to improve infection control measures to limit the spread of infection

Estee Torok

Spc. Miguel Pena

Taking a swab to test for SARS-CoV-2 (COVID-19)

Yes

Licence type:

Public Domain

Testing suggests 3% of NHS hospital staff may be unknowingly infected with coronavirus

cjb250 — Tue, 12 May 2020 10:42:25 +0000

Patients admitted to NHS hospitals are now routinely screened for the SARS-CoV-2 virus, and isolated if necessary. But NHS workers, including patient-facing staff on the front line, such as doctors, nurses and physiotherapists, are tested and excluded from work only if they develop symptoms of the illness. Many of them, however, may show no symptoms at all even if infected, as a new study published in the journal eLife demonstrates.

̽��ֱ��Cambridge team pro-actively swabbed and tested over 1,200 NHS staff at Addenbrooke’s Hospital, Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust, throughout April. ̽��ֱ��samples were analysed using a technique called PCR to copy and read the genetic information of material present on the swab, producing a colour change whenever the coronavirus was present in a specimen. At the same time, staff members were asked about relevant coronavirus symptoms.

Of the more than 1,000 staff members reporting fit for duty during the study period, 3% nevertheless tested positive for the coronavirus. On closer questioning, around one in five reported no symptoms, two in five had very mild symptoms that they had dismissed as inconsequential, and a further two in five reported COVID-19 symptoms that had stopped more than a week previously.

To probe routes of possible transmission of the virus through the hospital and among staff, the researchers also looked at whether rates of infection were greater among staff working in “red” areas of the hospital, those areas caring for COVID-19 patients. Despite wearing appropriate personal protective equipment (PPE), “red” area staff were three times more likely to tested positive than staff working in COVID-19 free “green” areas. It’s not clear whether this genuinely reflects greater rates of transmission from patients to staff in red areas. Staff may have instead transmitted the virus to each other or acquired it at home. Staff working in the “red” areas were also swabbed earlier in the study, closer to when the lockdown was first initiated, so the higher rates of infection in this group might just be a symptom of higher rates of virus circulating in the community at the time.

Nevertheless, extrapolating these results to the more than half a million patient-facing staff working across the NHS UK-wide suggests that as many as 15,000 workers may have been on duty and infected, with the potential to transmit the virus to co-workers, family members and patients, during the month of April. In fact, this figure could be even higher in settings where the supply of PPE has been very problematic.

̽��ֱ��implications of the new study, say senior authors Dr Mike Weekes and Professor Stephen Baker from the Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), are that hospitals need to be vigilant and introduce screening programmes across their workforces.

“Test! Test! Test! And then test some more,” Dr Weekes explains. “All staff need to get tested regularly for COVID-19, regardless of whether they have any sort of symptoms – this will be vital to stop infection spreading within the hospital setting.”

̽��ֱ��research was mainly funded by Wellcome and the Addenbrooke’s Charitable Trust.

Reference
Rivett, L, et al. Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission. eLife; 11 May 2020; DOI: 10.7554/eLife.58728

Hospital staff may be carrying SARS-CoV-2, the coronavirus that causes COVID-19 disease, without realising they are infected, according to a study by researchers at the ̽��ֱ�� of Cambridge.

Test! Test! Test! And then test some more

Mike Weekes

Hospital CLÍNIC

Hospital staff

Yes

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